Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD00046505 | WA |
N | 2080P0202X | Pediatric Cardiologist | D72813 | MD |
N | 2080P0202X | Pediatric Cardiologist | MD00046508 | WA |
Y | 2080P0202X | Pediatric Cardiologist | MD461166 | PA |
NPI | 1194761312 |
---|---|
Provider Name | Phat P Pham |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 11/01/2022 |